Body changes after treatment

Changes in body appearance

If the way your body looks has changed after cancer treatment, you may feel self-conscious. It’s common to feel a range of emotions about the physical changes caused by treatment, which may include: changes to body functions; removal of a body part and use of a prosthesis; having a stoma; loss of hair from the head and body; weight loss or weight gain; skin rashes; swelling of part of the body (lymphoedema); and scars.

Some cancers of the head and neck can cause significant changes to what you look like, how you speak and how you eat or breathe. This can be upsetting because the change is visible, and kissing, speech and eating may be affected.

The way you look may affect how you feel about yourself. Changes to your face or body may make you feel less attractive, and this can affect your sexual confidence, self-esteem and body image. Often people find that their partner (or a potential partner) isn’t as concerned about these changes as they are. You may worry about other people’s reactions to you, or worry that they will avoid or reject you when they see how your body has changed.

It takes time to adjust to changes in appearance. Some physical changes may improve with time, while others may be more long-lasting. Focus on yourself as a whole person and not just the part that has changed.

Look Good Feel Better program

This free 2-hour program teaches adults and teens how to use skin care, hats and wigs to help restore appearance and self-esteem during and after treatment. Visit lgfb.org.au to book into a workshop. They can also send you a confidence kit if you can’t attend in person.

Tips for adjusting to appearance changes

• Remember that sexual attraction is based on a mix of emotional and physical factors, not on a body part or physical characteristic.
• Look and touch your scars to get used to the changes.
• Use clothing, make-up or accessories that make you feel good or highlight your favourite features.
• Consider showing your partner any body changes before sex – and talk through what feels okay. Having your partner look at and touch these areas may help both of you get more comfortable with the changes.
• If you feel uncomfortable about a part of your body, you can wear clothes to cover it during sex – e.g. if you have had breast surgery you may choose to wear a camisole. You may also prefer to avoid sexual positions that leave the area exposed.
• Look at and touch your scars so you get used to the changes.
• Dim the lights or light candles when you have sex until you feel more confident about your body.
• If your hair has fallen out, you can wear a hat, wig or scarf, or you may prefer to leave your head uncovered.
• If you have concerns about weight loss or gain, choose well-fitting clothes. Something too tight or too baggy may highlight weight changes. Consider treating yourself to a new outfit that makes you feel comfortable.
• Ask your doctor about the possibility of plastic surgery or a facial prosthesis if surgery or radiation therapy has affected your face. This may help you regain a more natural appearance and help with any changes in the way you speak.
• See a counsellor to help you adjust to the changes.

Removal of a body part

If your cancer treatment involved the removal of a limb, breast or part of your genitals, it can cause feelings of grief, loss and anger. This can affect your sexual desire and your sexual confidence. It takes time to get used to how your body has changed and how that makes you feel. Try to remind yourself that you are loved for who you are, not for your particular body parts. Talking to a psychologist or counsellor may help you improve your sex life and relationship, and ease distress after surgery.

Breast – Nipple and breast sensation usually stay the same after breast-conserving surgery, but may change after mastectomy. This can affect  sexual arousal if you like being touched on the breast. The surgery may make you feel self-conscious or like you’ve lost a part of your identity.

Prostheses – People who’ve had a breast or testicle removed may use a prosthesis to improve self-esteem. This is a personal decision and not something everyone wants. Your specialist can give you more information about your options and what the procedure involves.

Anus – The removal of the anus is a major change, particularly if you have anal sex. It is a key erogenous zone for many people, and though some sex acts may not be possible, you can express intimacy through oral sex, cuddling and stroking. Penetration of the stoma (the opening created to remove waste after surgery) is not an option – it can cause serious physical harm and infections can be passed through the stoma.

Prostate – If the prostate is removed to treat prostate cancer, it can affect sexual pleasure when receiving anal penetration. For support, visit the Prostate Cancer Foundation of Australia and see ‘Understanding prostate cancer booklet for LGBTIQA+ people’.

Tips for sex and intimacy after the removal of a body part

• Look at yourself naked in the mirror to get used to the changes to your body, or use a handheld mirror to see the genital area.
• Show your partner the changes. If it feels okay, teach them how to touch the area in a way that feels nice.
• Accept that it may take time to feel comfortable about your body again.
• If you have had one or both breasts removed, see our ‘Breast Prostheses and Reconstruction’ page for more information.
• Touch your genitals to work out how your response has changed and what feels good. Explore other areas of your body that make you feel aroused when touched. This may take time and practice.
• If you are worried about the reaction of your partner (or a potential partner), remember that good communication will help. Sharing your concerns and keeping an open mind will help you explore new ways to be intimate.
• Ask your partner to stroke different areas of your body if your usual erogenous zone has been affected. This may include kissing and touching your neck, ears, inner thighs and genital area.
• If you’ve had a limb removed, try wearing your limb prosthesis during sex. If you prefer to take off the prosthesis, use pillows to support the affected limb.
• Call Cancer Council 13 11 20 to talk to someone neutral about your feelings.
• Talk to a sexual health physician, psychosexual counsellor or sexual therapist about the ways any change to your body may be affecting your relationship and sex life. Visit societyaustraliansexologists.org.au to find an accredited sexologist near you.

Adapting to life with a stoma

Some types of surgery for bowel, anal or bladder cancer create a stoma – an opening in the abdomen that allows faeces (poo) or urine (pee or wee) to flow through and be collected in a small plastic bag. Sometimes a stoma is needed for only a short time, but in other cases it is permanent.

Having a stoma can affect your confidence and self-image, though a stoma often causes more embarrassment and distress to the person with a stoma than their partner. Getting used to looking after the stoma will help you feel more confident. Sexual activity for people with a stoma may need a little more planning but can still be satisfying and fulfilling.

Tips for sex if you have a stoma

• Change the bag and check the seal before having sex. This may help with worries about leaking.
• If you prefer, cover your bag with fabric or fold it in half and cover with a cummerbund to prevent the plastic clinging to your skin or the bag from flopping around. This can also help to keep it out of sight if that is a concern.
• Wear clothing that makes you feel good, such as a mini-slip, short nightgown or nightshirt, specially designed underwear or boxer shorts.
• Try sex in the bath/shower.
• After a heavy meal, wait for 2–3 hours before having sex.
• Talk to your stomal therapy nurse about learning irrigation to allow you to use a stoma cap or a small pouch (a “mini”) during sex.
• Use pouch deodorants or wear perfume to help control any odours.
• Allow your partner to see or touch the stoma.
• Contact a stoma association for support. Find one near you at australianstoma.com.au.

Early menopause

Natural menopause occurs when your ovaries stop working and you no longer menstruate (have periods). This means you will not be able to fall pregnant naturally. For most people, this usually happens between 45 and 55.

Most menopause symptoms are related to a drop in your body’s oestrogen levels. Symptoms may include aching joints, mood changes, hot flushes, night sweats, trouble sleeping, a dry vagina, reduced libido, dry or itchy skin, increased urinary frequency and “fuzzy” thinking. However, some people have few or minor symptoms.

Early menopause (premature ovarian insufficiency or POI) is the term for menopause that occurs before the age of 40. When this happens because of cancer treatment, it may be called induced menopause. When menopause starts suddenly, the symptoms are usually more severe than natural menopause because your body hasn’t had time to get used to the gradual loss of hormones. Premature menopause may also cause bones to weaken (called osteoporosis or osteopenia).

Going through menopause earlier than you expected may affect your sense of identity, or make you feel older than your age or friends. You may feel less feminine, and worry that you are not as attractive. For some people, not having periods is a positive.

Many kinds of cancer treatments can result in menopause symptoms or early menopause. These treatments include: surgery in which both of your ovaries are removed; hormone therapy to decrease your body’s production of oestrogen; and radiation therapy and chemotherapy, which may affect your ovaries’ ability to produce eggs and hormones.

If your uterus is removed (hysterectomy) you will no longer have monthly periods or be able to carry a child. However, if you still have at least one ovary, you will continue to produce oestrogen – which means you will go through natural menopause at the normal stage of life. If both of your  ovaries and/or your uterus are removed, your periods will stop and you will experience a surgical menopause.

Tips for managing menopause symptoms

• If cancer treatment causes early menopause, consider seeing a menopause clinic to discuss the options for managing symptoms.
• Identify and avoid things that trigger hot flushes, such as alcohol, hot drinks, spicy foods or anxiety.
• Learn meditation and relaxation techniques, and exercise regularly to reduce stress and symptoms.
• Try topical hormone treatments, such as vaginal creams, to manage symptoms. There are also non-hormonal options, such as acupuncture.
• Talk to your doctor about the benefits and risks of menopause hormone therapy (MHT) for severe menopause symptoms.
• Ask your GP to arrange a bone density test to check for osteoporosis or osteopenia, which can develop after menopause.
• Try to eat high-calcium foods, talk to your doctor about a supplement, and exercise regularly to strengthen your bones and reduce bone loss. For more information, visit Healthy Bones Australia or call them on 1800 242 141.

Fertility issues

Some cancer treatments can cause infertility (difficulty conceiving a baby), which can be temporary or permanent. If fertility is important to you, talk to your doctor before your treatment starts about the risks and your options. It may be possible to store your eggs, embryos, ovarian tissue or sperm for use in the future.

When people learn that they may be permanently infertile, they often feel a great sense of loss. You may be devastated that you won’t have your own children or have more children, and you may worry about the impact of this on your relationships. Even if your family is complete or you didn’t want children, you may experience strong emotions. This can change how you feel about yourself as a sexual being and affect your sexuality.

As well as talking with your partner, it may help to talk with a counsellor, sex therapist, your GP or your cancer treatment team.

If female reproductive organs are affected – Surgery that removes part or all of the reproductive organs, such as the ovaries, fallopian tubes, uterus and cervix, will cause your periods to stop and you will be unable to conceive a child.

Depending on the type of chemotherapy drugs used and the dose, periods may become irregular but they often return after treatment ends. In some cases, periods stop permanently, leading to menopause.

If sperm production is affected – Surgery for bladder, prostate or testicular cancer may damage the nerves for getting and keeping an erection. This may be temporary, but some people may not get strong erections again, or have permanent erection issues. If the problem is ongoing, ask your doctor about collecting sperm.

Chemotherapy may reduce or stop sperm production and affect the ability of sperm to move. This can sometimes cause temporary or permanent infertility.

If you have radiation therapy in the pelvic or groin area, you may have temporary or permanent fertility problems after treatment. If your testicles are outside the treatment area, they can usually be protected. Radiation therapy to the brain may damage the pituitary gland, which affects both the production of sperm and sex drive.

Tips for managing fertility and treatment

• If you think you may want to have children in the future, discuss ways to preserve or protect your fertility with a fertility specialist before cancer treatment begins.
• Share your feelings about any fertility issues with your partner, who may also be worried or grieving.
• Ask your doctor what precautions to use during treatment. You may need to use barrier contraception, such as condoms or female condoms, to   reduce any potential risk of the treatments harming a developing baby or being toxic to your partner.
• Tell your cancer specialist immediately if you or your partner become pregnant during treatment.
• Consider having tests to check if your fertility has been affected.

For more information download our ‘Fertility and Cancer’ booklet.

Adapting to life after a brain tumour

As brain tumours do not affect sexual organs, you may not expect sexuality to change. However the brain is responsible for sexual urges,
thoughts and behaviours. The areas most commonly involved in sexual functioning include the frontal, temporal and parietal lobe, and pituitary gland. When these
parts are injured, it can cause problems with behaviour, thinking and memory, personality and social skills.

Possible changes in sexuality after a brain tumour include:

• loss of libido or sexual drive
• having an increased desire for sex (hypersexual)
• inability to achieve or maintain an erection
• difficulty or inability to orgasm
• premature ejaculation
• talking a lot about sex or inappropriate touching (disinhibition)
• weakness in an arm or leg, or slow and uncoordinated movements
• fatigue
• changes in self-image and relationships.

If you have become uninhibited or hypersexual after surgery, your family and friends may ask you to masturbate in private and not
to make sexual comments. For help following brain cancer, call Cancer Council on 13 11 20 or visit buildingthebridge.com.au.

The most distressing time for me was immediately post op when my side effects were many, varied and quite severe, even though most turned out to be temporary.” – Ian